Sexual and Reproductive Health

The Challenge: Barriers to Sexual and Reproductive Health

In many low- and middle-income countries (LMICs), access to sexual and reproductive health (SRH) products and services remains limited — especially for women and girls. These gaps increase the risks of preventable health issues, unintended pregnancies and even maternal mortality, while also disrupting education and economic opportunities, reinforcing structural barriers to gender equity. The impacts extend beyond individuals, affecting families, communities and the wider society.

Meanwhile, declining donor funding for SRH commodities is putting growing pressure on governments to assume financial and operational responsibility for ensuring access. Yet many domestic systems are unprepared to manage this shift. Persistent health system constraints — from shortages of trained providers to uneven quality of care and counseling and weak data systems — limit effective service delivery. Fragile supply chains and market inefficiencies contribute to frequent stock-outs and unreliable access to essential SRH products. At the same time, deeply rooted gender norms, stigma, and financial and geographic inequities continue to prevent women, girls and other marginalized groups from accessing care.

The Opportunity to Improve Access

Results for Development (R4D) is supporting countries to strengthen domestic financing, shape markets and improve delivery systems for SRH — not only to address immediate gaps but to create resilient markets and health care systems that ensure women and girls can lead healthier, more empowered lives now and into the future.

R4D is globally recognized for its deep expertise in health financing, market shaping, and service delivery design — and for its ability to integrate and align these levers to drive sustainable and equitable systems change, improving health outcomes and life opportunities for women and girls. Key features include:

• Domestic resource mobilization: Strengthening domestic financing mechanisms to increase sustainable funding for SRH products and services.
• Coordinated and aligned financing: aligning public, private, and donor resources behind country-led priorities to maximize impact, reduce fragmentation, and create sustainable financing for SRH products and services.
• Market analysis and performance diagnostics: Identifying and addressing the root causes of challenges and inefficiencies in SRH commodity availability, financing, supply chains, channel optimization, and service delivery — with a focus on ensuring women and girls have reliable options and choice.
• Engaging the private sector: Strengthening private health markets by improving market intelligence, expanding access to financing, and building the capacity of private providers to sustainably deliver high-quality SRH products and services that meet the needs of women and girls.
• Strategic Purchasing: Supporting governments to use their significant purchasing power more strategically — making informed decisions about what SRH services and products to buy, from whom and at what cost — to improve quality, equity and efficiency with limited resources.
• Digital systems & data use: Strengthening the use of digital tools and data analysis to support decision-making and drive timely actions that strengthen supply chains and enhance access to sexual and reproductive health services and products.
• Diverse stakeholder engagement: Bringing together diverse actors to align goals, build ownership, steward markets, and co-design strategies that reflect women’s voices and priorities.
• Adaptive implementation: Collaboratively monitoring progress, learning from challenges, and adjusting strategies to ensure women and girls experience lasting improvements in health, choice and equity.

R4D’s Work: Supporting Countries to Strengthen SRH Systems

• Increasing access to health commodities for women and girls in Tanzania: R4D is supporting the Government of Tanzania to strengthen markets for reproductive, maternal, newborn, child, and adolescent health (RMNCAH) products by improving planning, budgeting and resource allocation at national and subnational levels. The partnership, known as Improving Market Access and Financing for Health (IMAF-H), is conducting a comprehensive market diagnostic and public financial management assessment to identify the root causes of limited commodity availability and inadequate financing. Based on these insights, R4D and Tanzanian leaders will co-design strategies for market management and domestic resource mobilization to ensure the availability and sustainability of RMNCAH products and services. The project also focuses on strengthening capacity for commodity monitoring, subnational planning, and implementing health financing mechanisms, particularly in support of Tanzania’s Universal Health Insurance law.
• Strengthening private sector markets for family planning and health products: As the technical lead for the Frontier Health Market (FHM) Engage Project (2021-2024), R4D and partners identified and designed interventions to address underperformance in private sector markets, including family planning and other health products, across nine countries—Ghana, India, Kenya, Liberia, Madagascar, Nepal, Nigeria, Sierra Leone, Tanzania, and Zambia. A key focus of R4D’s work was in Tanzania, where we supported the development of the Tanzania Market Analytics Platform for Health (T-MAP), which integrated siloed data from public and private sources to improve decision-making. T-MAP features dashboards like the Condom Dashboard, enabling stakeholders to track market trends, and the Private Sector Health Facilities Map, which aids in scaling up FP and HIV services. R4D also improved market intelligence for contraceptives, helping suppliers forecast demand and reduce stockouts. Additionally, R4D boosted financial resources for family planning commodity service delivery by increasing private lending sevenfold through a Development Finance Corporation loan guarantee. R4D also enhanced financial literacy for young health professionals via the Kuza Project.
• Strengthening supply chains for reproductive, maternal, newborn, child, and adolescent health and nutrition products: Through the Access Procurement and Distribution Channels (Access PDC) project, R4D is partnering with the Global Financing Facility (GFF) to help countries improve their mixed supply chain systems for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N) products. R4D’s work focuses on two main areas: (1) developing a methodology to map procurement and distribution channels, identify bottlenecks, and uncover opportunities for investment and policy reform; and (2) creating advocacy toolkits to help countries use the findings to mobilize resources and address supply chain challenges. Currently being implemented in Madagascar, Nigeria, and Kenya, the Access PDC methodology will inform similar efforts in additional GFF countries, driving more efficient and equitable health product distribution in the future.
• Improving health outcomes for women, children, and adolescents through rapid-cycle analytics: R4D is partnering with the Global Financing Facility (GFF) to expand the Frequent Assessments and Systems Tools for Resilience (FASTR) Initiative in Ghana and Nigeria. The project aims to strengthen primary health care (PHC) systems by providing countries with timely, rigorous and practical data to monitor health system performance – particularly for reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH-N) services. R4D’s work includes adapting FASTR’s rapid-cycle analytic tools, such as phone surveys and household surveys, to meet country-specific data needs and building data use processes at both national and subnational levels. Through this work, R4D helps countries turn data into actionable insights for improving PHC delivery. The project will generate lessons to scale FASTR’s tools across other countries, contributing to global health improvement through more effective and equitable health service delivery.